ArticleTrials2025
Effect of perioperative repetitive transcranial magnetic stimulation on postoperative cognitive function and peripheral inflammation in elderly total knee arthroplasty patients: study protocol for a randomized controlled trial.
Article in Trials, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
- Regulatory T cells in perioperative neurocognitive disorders: a systematic review with structured narrative synthesis from molecular mechanisms to clinical translation.Frontiers in molecular neuroscience · 2026Pooled it
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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
Abstract
backgroundPostoperative cognitive dysfunction (POCD) is a serious and common complication after total knee arthroplasty (TKA) in the elderly. Studies have suggested that repetitive transcranial magnetic stimulation (rTMS) can reduce the levels of tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6) inflammatory factors in the hippocampus, inhibit neuroinflammatory responses in the brain, and reduce the damage to synapses, thereby improving cognitive dysfunction. However, the effectiveness of rTMS for POCD remains to be explored. Therefore, the aim of this study is to treat POCD after TKA in the elderly with rTMS to evaluate the clinical efficacy of rTMS for POCD.
methodsThis single-center, randomized, sham-controlled, assessor-blinded, parallel-group trial will enroll 207 elderly patients undergoing TKA and allocate them 1:1:1 to control group, active rTMS group, or sham rTMS group. All participants will receive standardized perioperative management. In addition, patients randomized to the active rTMS group will undergo stimulation of the left dorsolateral prefrontal cortex (DLPFC) at 10 Hz, 2000 pulses per session (5 s trains with 25 s inter-train intervals; 100% resting motor threshold), once daily for five consecutive pre-operative days. The sham rTMS group will follow the identical target and schedule, but the coil will be oriented perpendicular to the skull to avoid effective cortical stimulation. Primary outcome includes incidence of POCD at postoperative day seven (MoCA-based item-level definition). Secondary outcomes include changes in the MoCA total score and a prespecified cognitive subtest battery comprising the Digit Span Test (DST), Digit Symbol Substitution Test (DSST), Trail Making Test (TMT), and Delayed Story Recall (DSR), together with changes in serum inflammatory markers (IL-1β, IL-6, TNF-α, and HMGB1), assessed at preoperative day six, preoperative day one, postoperative day three, and postoperative day seven. DISCUSSION: This trial will contribute to addressing the effectiveness of perioperative rTMS stimulation in elderly patients with TKA, and will initially clarify that perioperative rTMS preventive intervention can produce neuroprotective effects to reduce oxidative stress and inflammation, and to some extent block the possible pathway of POCD occurrence, thereby reducing the risk of POCD occurrence.
trial registrationClinicalTrials.gov ChiCTR2400081372. Registered on 29 February 2024.
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